Subnormothermic ex vivo liver perfusion reduces endothelial cell and bile duct injury after donation after cardiac death pig liver transplantation
Open Access
- 1 September 2014
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Liver Transplantation
- Vol. 20 (11), 1296-1305
- https://doi.org/10.1002/lt.23986
Abstract
An ischemic‐type biliary stricture (ITBS) is a common feature after liver transplantation using donation after cardiac death (DCD) grafts. We compared sequential subnormothermic ex vivo liver perfusion (SNEVLP; 33°C) with cold storage (CS) for the prevention of ITBS in DCD liver grafts in pig liver transplantation (n = 5 for each group). Liver grafts were stored for 10 hours at 4°C (CS) or preserved with combined 7‐hour CS and 3‐hour SNEVLP. Parameters of hepatocyte [aspartate aminotransferase (AST), international normalized ratio (INR), factor V, and caspase 3 immunohistochemistry], endothelial cell (EC; CD31 immunohistochemistry and hyaluronic acid), and biliary injury and function [alkaline phosphatase (ALP), total bilirubin, and bile lactate dehydrogenase (LDH)] were determined. Long‐term survival (7 days) after transplantation was similar between the SNEVLP and CS groups (60% versus 40%, P = 0.13). No difference was observed between SNEVLP‐ and CS‐treated animals with respect to the peak of serum INR, factor V, or AST levels within 24 hours. CD31 staining 8 hours after transplantation demonstrated intact EC lining in SNEVLP‐treated livers (7.3 × 10−4 ± 2.6 × 10−4 cells/μm2) but not in CS‐treated livers (3.7 × 10−4 ± 1.3 × 10−4 cells/μm2, P = 0.03). Posttransplant SNEVLP animals had decreased serum ALP and serum bilirubin levels in comparison with CS animals. In addition, LDH in bile fluid was lower in SNEVLP pigs versus CS pigs (14 ± 10 versus 60 ± 18 μmol/L, P = 0.02). Bile duct histology revealed severe bile duct necrosis in 3 of 5 animals in the CS group but none in the SNEVLP group (P = 0.03). Sequential SNEVLP preservation of DCD grafts reduces bile duct and EC injury after liver transplantation. Liver Transpl 20:1296‐1305, 2014. © 2014 AASLD.Keywords
This publication has 26 references indexed in Scilit:
- Perfusion machines for liver transplantation: technology and multifunctionalityUpdates in Surgery, 2013
- Biliary Complications After Liver Transplantation: Old Problems and New ChallengesAmerican Journal of Transplantation, 2013
- Extracorporeal machine liver perfusionCurrent Opinion in Organ Transplantation, 2012
- Ischemia-Reperfusion Injury and Ischemic-Type Biliary Lesions following Liver TransplantationJournal of Transplantation, 2012
- Donation after cardio-circulatory death liver transplantationWorld Journal of Gastroenterology, 2012
- Current status of donation after cardiac death liver transplantationCurrent Opinion in Organ Transplantation, 2010
- Incidence of and risk factors for ischemic-type biliary lesions following orthotopic liver transplantationTransplant International, 2009
- Organ DonationSeminars in Liver Disease, 2009
- Biliary complications and outcomes of liver transplantation from donors after cardiac deathLiver Transplantation, 2007
- Liver Transplantation After Organ Preservation With Normothermic Extracorporeal PerfusionAnnals of Surgery, 2001